1199SEIU Benefit Funds Claims Management Procedure List: Cardiology &

Included w/ Category CPT® Code CPT® Code Description Claims Management 3D rendering with interpretation and reporting of computed , magnetic resonance imaging, ultrasound, 3D Imaging 76377 or other tomographic modality with image postprocessing under concurrent supervision; requiring image X postprocessing on an independent workstation 3D rendering with interpretation and reporting of computed tomography, magnetic resonance imaging, ultrasound, 3D Imaging 76376 or other tomographic modality with image postprocessing under concurrent supervision; not requiring image X postprocessing on an independent workstation

Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection BMRI 77049 X (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; bilateral

Magnetic resonance imaging, breast, without and with contrast material(s), including computer-aided detection BMRI 77048 X (CAD real-time lesion detection, characterization and pharmacokinetic analysis), when performed; unilateral

BMRI 77047 Magnetic resonance imaging, breast, without contrast material; bilateral X BMRI 77046 Magnetic resonance imaging, breast, without contrast material; unilateral X Use of echocardiographic contrast agent during stress (List separately in addition to code for Cardiac Services 93352 X primary procedure)

Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically Cardiac Services 93351 X induced stress, with interpretation and report; including performance of continuous electrocardiographic monitoring, with supervision by a physician or other qualified health care professional

Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when Cardiac Services 93350 performed, during rest and cardiovascular stress test using treadmill, bicycle exercise and/or pharmacologically X induced stress, with interpretation and report;

Cardiac Services 93325 Doppler echocardiography color flow velocity mapping (List separately in addition to codes for echocardiography) X Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to Cardiac Services 93321 codes for echocardiographic imaging); follow-up or limited study (List separately in addition to codes for X echocardiographic imaging)

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Doppler echocardiography, pulsed wave and/or continuous wave with spectral display (List separately in addition to Cardiac Services 93320 X codes for echocardiographic imaging); complete

Echocardiography, transesophageal (TEE) for monitoring purposes, including probe placement, real time 2- Cardiac Services 93318 dimensional image acquisition and interpretation leading to ongoing (continuous) assessment of (dynamically X changing) cardiac pumping function and to therapeutic measures on an immediate time basis Transesophageal echocardiography for congenital cardiac anomalies; image acquisition, interpretation and report Cardiac Services 93317 X only

Cardiac Services 93316 Transesophageal echocardiography for congenital cardiac anomalies; placement of transesophageal probe only X Transesophageal echocardiography for congenital cardiac anomalies; including probe placement, image Cardiac Services 93315 X acquisition, interpretation and report Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); Cardiac Services 93314 X image acquisition, interpretation and report only Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); Cardiac Services 93313 X placement of transesophageal probe only Echocardiography, transesophageal, real-time with image documentation (2D) (with or without M-mode recording); Cardiac Services 93312 X including probe placement, image acquisition, interpretation and report Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when Cardiac Services 93308 X performed, follow-up or limited study Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when Cardiac Services 93307 X performed, complete, without spectral or color Doppler echocardiography Echocardiography, transthoracic, real-time with image documentation (2D), includes M-mode recording, when Cardiac Services 93306 X performed, complete, with spectral Doppler echocardiography, and with color flow Doppler echocardiography

Cardiac Services 93304 Transthoracic echocardiography for congenital cardiac anomalies; follow-up or limited study X

Cardiac Services 93303 Transthoracic echocardiography for congenital cardiac anomalies; complete X Contrast Q9968 Injection, non-radioactive, non-contrast, visualization adjunct (e.g., methylene blue, isosulfan blue), 1 mg X Pharmaceutical Contrast Q9967 Low osmolar contrast material, 300-399 mg/ml iodine concentration, per ml X Pharmaceutical Contrast Q9966 Low osmolar contrast material, 200-299 mg/ml iodine concentration, per ml X Pharmaceutical Contrast Q9965 Low osmolar contrast material, 100-199 mg/ml iodine concentration, per ml X Pharmaceutical Contrast Q9964 High osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml X Pharmaceutical

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Contrast Q9963 High osmolar contrast material, 350-399 mg/ml iodine concentration, per ml X Pharmaceutical Contrast Q9962 High osmolar contrast material, 300-349 mg/ml iodine concentration, per ml X Pharmaceutical Contrast Q9961 High osmolar contrast material, 250-299 mg/ml iodine concentration, per ml X Pharmaceutical Contrast Q9960 High osmolar contrast material, 200-249 mg/ml iodine concentration, per ml X Pharmaceutical Contrast Q9959 High osmolar contrast material, 150-199 mg/ml iodine concentration, per ml X Pharmaceutical Contrast Q9958 High osmolar contrast material, up to 149 mg/ml iodine concentration, per ml X Pharmaceutical Contrast Q9957 Injection, perflutren lipid microspheres, per ml X Pharmaceutical Contrast Q9954 Oral magnetic resonance contrast agent, per 100 ml X Pharmaceutical Contrast Q9953 Injection, iron-based magnetic resonance contrast agent, per ml X Pharmaceutical Contrast Q9951 Low osmolar contrast material, 400 or greater mg/ml iodine concentration, per ml X Pharmaceutical Contrast A9580 Sodium fluoride f-18, diagnostic, per study dose, up to 30 millicuries X Pharmaceutical Contrast A9578 Injection, gadobenate dimeglumine (multihance multipack), per ml X Pharmaceutical Contrast A9577 Injection, gadobenate dimeglumine (multihance), per ml X Pharmaceutical

Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study CPET 78433 (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (eg, myocardial X viability); with concurrently acquired computed tomography transmission scan

Myocardial imaging, positron emission tomography (PET), combined perfusion with metabolic evaluation study CPET 78432 (including ventricular wall motion[s] and/or ejection fraction[s], when performed), dual radiotracer (eg, myocardial X viability); Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] CPET 78431 and/or ejection fraction[s], when performed); multiple studies at rest and stress (exercise or pharmacologic), with X concurrently acquired computed tomography transmission scan Myocardial imaging, positron emission tomography (PET), perfusion study (including ventricular wall motion[s] CPET 78430 and/or ejection fraction[s], when performed); single study, at rest or stress (exercise or pharmacologic), with X concurrently acquired computed tomography transmission scan

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall CPET 78429 motion[s] and/or ejection fraction[s], when performed), single study; with concurrently acquired computed X tomography transmission scan CT G0297 Low Dose CT of the Chest For Lung Cancer Screening X Computer-aided detection (CAD) (computer algorithm analysis of digital image data for lesion detection) with CT 0175T further physician review for interpretation and report, with or without digitization of film radiographic images, chest X radiograph(s), performed remote from primary interpretation Computer-aided detection (CAD) (computer algorithm analysis of digital image data for lesion detection) with further physician review for interpretation and report, with or without digitization of film radiographic images, chest CT 0174T X radiograph(s), performed concurrent with primary interpretation (List separately in addition to code for primary procedure)

Cerebral perfusion analysis using computed tomography with contrast administration, including post-processing of CT 0042T X parametric maps with determination of cerebral blood flow, cerebral blood volume, and mean transit time

CT 77078 Computed tomography, bone mineral density study, 1 or more sites, axial skeleton (eg, hips, pelvis, spine) X

CT 77014 Computed tomography guidance for placement of radiation therapy fields X CT 77013 Computed tomography guidance for, and monitoring of, parenchymal tissue ablation X Computed tomography guidance for needle placement (eg, biopsy, aspiration, injection, localization device), CT 77012 X radiological supervision and interpretation CT 77011 Computed tomography guidance for stereotactic localization X CT 76497 Unlisted computed tomography procedure (eg, diagnostic, interventional) X CT 76380 Computed tomography, limited or localized follow-up study X Computed tomographic , abdominal and bilateral iliofemoral lower extremity runoff, with contrast CT 75635 X material(s), including noncontrast images, if performed, and image postprocessing Computed tomographic angiography, , coronary arteries and bypass grafts (when present), with contrast CT 75574 material, including 3D image postprocessing (including evaluation of cardiac structure and morphology, X assessment of cardiac function, and evaluation of venous structures, if performed)

Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology in the CT 75573 setting of congenital heart disease (including 3D image postprocessing, assessment of LV cardiac function, RV X structure and function and evaluation of venous structures, if performed)

Computed tomography, heart, with contrast material, for evaluation of cardiac structure and morphology (including CT 75572 X 3D image postprocessing, assessment of cardiac function, and evaluation of venous structures, if performed)

CT 75571 Computed tomography, heart, without contrast material, with quantitative evaluation of coronary calcium X

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management CT 74263 Computed tomographic (CT) colonography, screening, including image postprocessing X Computed tomographic (CT) colonography, diagnostic, including image postprocessing; with contrast material(s) CT 74262 X including non-contrast images, if performed

CT 74261 Computed tomographic (CT) colonography, diagnostic, including image postprocessing; without contrast material X Computed tomography, abdomen and pelvis; without contrast material in one or both body regions, followed by CT 74178 X contrast material(s) and further sections in one or both body regions CT 74177 Computed tomography, abdomen and pelvis; with contrast material(s) X CT 74176 Computed tomography, abdomen and pelvis; without contrast material X Computed tomographic angiography, abdomen, with contrast material(s), including noncontrast images, if CT 74175 X performed, and image postprocessing Computed tomographic angiography, abdomen and pelvis, with contrast material(s), including noncontrast images, CT 74174 X if performed, and image postprocessing

CT 74170 Computed tomography, abdomen; without contrast material, followed by contrast material(s) and further sections X

CT 74160 Computed tomography, abdomen; with contrast material(s) X CT 74150 Computed tomography, abdomen; without contrast material X Computed tomographic angiography, lower extremity, with contrast material(s), including noncontrast images, if CT 73706 X performed, and image postprocessing Computed tomography, lower extremity; without contrast material, followed by contrast material(s) and further CT 73702 X sections CT 73701 Computed tomography, lower extremity; with contrast material(s) X CT 73700 Computed tomography, lower extremity; without contrast material X Computed tomographic angiography, upper extremity, with contrast material(s), including noncontrast images, if CT 73206 X performed, and image postprocessing Computed tomography, upper extremity; without contrast material, followed by contrast material(s) and further CT 73202 X sections CT 73201 Computed tomography, upper extremity; with contrast material(s) X CT 73200 Computed tomography, upper extremity; without contrast material X

CT 72194 Computed tomography, pelvis; without contrast material, followed by contrast material(s) and further sections X

CT 72193 Computed tomography, pelvis; with contrast material(s) X CT 72192 Computed tomography, pelvis; without contrast material X Computed tomographic angiography, pelvis, with contrast material(s), including noncontrast images, if performed, CT 72191 X and image postprocessing

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Computed tomography, lumbar spine; without contrast material, followed by contrast material(s) and further CT 72133 X sections CT 72132 Computed tomography, lumbar spine; with contrast material X CT 72131 Computed tomography, lumbar spine; without contrast material X Computed tomography, thoracic spine; without contrast material, followed by contrast material(s) and further CT 72130 X sections CT 72129 Computed tomography, thoracic spine; with contrast material X CT 72128 Computed tomography, thoracic spine; without contrast material X Computed tomography, cervical spine; without contrast material, followed by contrast material(s) and further CT 72127 X sections CT 72126 Computed tomography, cervical spine; with contrast material X CT 72125 Computed tomography, cervical spine; without contrast material X Computed tomographic angiography, chest (noncoronary), with contrast material(s), including noncontrast images, CT 71275 X if performed, and image postprocessing

CT 71270 Computed tomography, thorax; without contrast material, followed by contrast material(s) and further sections X

CT 71260 Computed tomography, thorax; with contrast material(s) X CT 71250 Computed tomography, thorax; without contrast material X Computed tomographic angiography, neck, with contrast material(s), including noncontrast images, if performed, CT 70498 X and image postprocessing Computed tomographic angiography, head, with contrast material(s), including noncontrast images, if performed, CT 70496 X and image postprocessing Computed tomography, soft tissue neck; without contrast material followed by contrast material(s) and further CT 70492 X sections CT 70491 Computed tomography, soft tissue neck; with contrast material(s) X CT 70490 Computed tomography, soft tissue neck; without contrast material X Computed tomography, maxillofacial area; without contrast material, followed by contrast material(s) and further CT 70488 X sections CT 70487 Computed tomography, maxillofacial area; with contrast material(s) X CT 70486 Computed tomography, maxillofacial area; without contrast material X Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material, CT 70482 X followed by contrast material(s) and further sections

CT 70481 Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; with contrast material(s) X

CT 70480 Computed tomography, orbit, sella, or posterior fossa or outer, middle, or inner ear; without contrast material X

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Computed tomography, head or brain; without contrast material, followed by contrast material(s) and further CT 70470 X sections CT 70460 Computed tomography, head or brain; with contrast material(s) X CT 70450 Computed tomography, head or brain; without contrast material X Dexa 77086 Vertebral fracture assessment via dual-energy X-ray absorptiometry (DXA) X Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, Dexa 77085 X spine), including vertebral fracture assessment Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; appendicular skeleton (peripheral) Dexa 77081 X (eg, radius, wrist, heel) Dual-energy X-ray absorptiometry (DXA), bone density study, 1 or more sites; axial skeleton (eg, hips, pelvis, Dexa 77080 X spine) Diagnostic 77077 Joint survey, single view, 2 or more joints (specify) X Radiology Diagnostic 77076 Radiologic examination, osseous survey, infant X Radiology Diagnostic 77075 Radiologic examination, osseous survey; complete (axial and appendicular skeleton) X Radiology Diagnostic 77074 Radiologic examination, osseous survey; limited (eg, for metastases) X Radiology Diagnostic 77073 Bone length studies (orthoroentgenogram, scanogram) X Radiology Diagnostic 77072 Bone age studies X Radiology Diagnostic Manual application of stress performed by physician or other qualified health care professional for joint 77071 X Radiology , including contralateral joint if indicated Diagnostic Cineradiography/videoradiography to complement routine examination (List separately in addition to code for 76125 X Radiology primary procedure) Diagnostic 76120 Cineradiography/videoradiography, except where specifically included X Radiology Diagnostic Radiologic examination, complex motion (ie, hypercycloidal) body section (eg, mastoid polytomography), other than 76102 X Radiology with urography; bilateral Diagnostic Radiologic examination, complex motion (ie, hypercycloidal) body section (eg, mastoid polytomography), other than 76101 X Radiology with urography; unilateral Diagnostic 76100 Radiologic examination, single plane body section (eg, tomography), other than with urography X Radiology Diagnostic 76098 Radiological examination, surgical specimen X Radiology

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Diagnostic 76080 Radiologic examination, abscess, fistula or sinus tract study, radiological supervision and interpretation X Radiology Diagnostic 76010 Radiologic examination from nose to rectum for foreign body, single view, child X Radiology Diagnostic Placement of distal extension prosthesis(s) (delayed) after endovascular repair of descending thoracic aorta, as 75959 X Radiology needed, to level of celiac origin, radiological supervision and interpretation Placement of proximal extension prosthesis for endovascular repair of descending thoracic aorta (eg, aneurysm, Diagnostic 75958 pseudoaneurysm, dissection, penetrating ulcer, intramural hematoma, or traumatic disruption), radiological X Radiology supervision and interpretation Endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, Diagnostic intramural hematoma, or traumatic disruption); not involving coverage of left subclavian artery origin, initial 75957 X Radiology endoprosthesis plus descending thoracic aortic extension(s), if required, to level of celiac artery origin, radiological supervision and interpretation Endovascular repair of descending thoracic aorta (eg, aneurysm, pseudoaneurysm, dissection, penetrating ulcer, Diagnostic intramural hematoma, or traumatic disruption); involving coverage of left subclavian artery origin, initial 75956 X Radiology endoprosthesis plus descending thoracic aortic extension(s), if required, to level of celiac artery origin, radiological supervision and interpretation Diagnostic 74775 Perineogram (eg, vaginogram, for sex determination or extent of anomalies) X Radiology Diagnostic 74710 Pelvimetry, with or without placental localization X Radiology Diagnostic 74420 Urography, retrograde, with or without KUB X Radiology Diagnostic 74415 Urography, infusion, drip technique and/or bolus technique; with nephrotomography X Radiology Diagnostic 74410 Urography, infusion, drip technique and/or bolus technique; X Radiology Diagnostic 74400 Urography (pyelography), intravenous, with or without KUB, with or without tomography X Radiology Diagnostic and/or pancreatography; additional set intraoperative, radiological supervision and interpretation 74301 X Radiology (List separately in addition to code for primary procedure) Diagnostic 74300 Cholangiography and/or pancreatography; intraoperative, radiological supervision and interpretation X Radiology Diagnostic 74290 , oral contrast X Radiology Diagnostic 74260 Duodenography, hypotonic X Radiology Diagnostic Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, effervescent 74249 X Radiology agent, with or without glucagon; with small intestine follow-through

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Diagnostic 74220 Radiologic examination; esophagus X Radiology Diagnostic 74210 Radiologic examination; pharynx and/or cervical esophagus X Radiology Diagnostic 74190 Peritoneogram (eg, after injection of air or contrast), radiological supervision and interpretation X Radiology Diagnostic Radiologic examination, abdomen; complete acute abdomen series, including supine, erect, and/or decubitus 74022 X Radiology views, single view chest Diagnostic 74021 X-ray of abdomen, minimum of 3 views X Radiology Diagnostic 74019 X-ray of abdomen, 2 views X Radiology Diagnostic 74018 X-ray of abdomen, single view X Radiology Diagnostic 73660 Radiologic examination; toe(s), minimum of 2 views X Radiology Diagnostic 73650 Radiologic examination; calcaneus, minimum of 2 views X Radiology Diagnostic 73630 Radiologic examination, foot; complete, minimum of 3 views X Radiology Diagnostic 73620 Radiologic examination, foot; 2 views X Radiology Diagnostic 73610 Radiologic examination, ankle; complete, minimum of 3 views X Radiology Diagnostic 73600 Radiologic examination, ankle; 2 views X Radiology Diagnostic 73592 Radiologic examination; lower extremity, infant, minimum of 2 views X Radiology Diagnostic 73590 Radiologic examination; tibia and fibula, 2 views X Radiology Diagnostic 73565 Radiologic examination, knee; both knees, standing, anteroposterior X Radiology Diagnostic 73564 Radiologic examination, knee; complete, 4 or more views X Radiology Diagnostic 73562 Radiologic examination, knee; 3 views X Radiology Diagnostic 73560 Radiologic examination, knee; 1 or 2 views X Radiology

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Diagnostic 73552 Radiologic examination, femur; minimum 2 views X Radiology Diagnostic 73551 Radiologic examination, femur; 1 view X Radiology Diagnostic 73523 Radiologic examination, hips, bilateral, with pelvis when performed; minimum of 5 views X Radiology Diagnostic 73522 Radiologic examination, hips, bilateral, with pelvis when performed; 3-4 views X Radiology Diagnostic 73521 Radiologic examination, hips, bilateral, with pelvis when performed; 2 views X Radiology Diagnostic 73503 Radiologic examination, hip, unilateral, with pelvis when performed; minimum of 4 views X Radiology Diagnostic 73502 Radiologic examination, hip, unilateral, with pelvis when performed; 2-3 views X Radiology Diagnostic 73501 Radiologic examination, hip, unilateral, with pelvis when performed; 1 view X Radiology Diagnostic 73140 Radiologic examination, finger(s), minimum of 2 views X Radiology Diagnostic 73130 Radiologic examination, hand; minimum of 3 views X Radiology Diagnostic 73120 Radiologic examination, hand; 2 views X Radiology Diagnostic 73110 Radiologic examination, wrist; complete, minimum of 3 views X Radiology Diagnostic 73100 Radiologic examination, wrist; 2 views X Radiology Diagnostic 73092 Radiologic examination; upper extremity, infant, minimum of 2 views X Radiology Diagnostic 73090 Radiologic examination; forearm, 2 views X Radiology Diagnostic 73080 Radiologic examination, elbow; complete, minimum of 3 views X Radiology Diagnostic 73070 Radiologic examination, elbow; 2 views X Radiology Diagnostic 73060 Radiologic examination; humerus, minimum of 2 views X Radiology Diagnostic 73050 Radiologic examination; acromioclavicular joints, bilateral, with or without weighted distraction X Radiology

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Diagnostic 73030 Radiologic examination, shoulder; complete, minimum of 2 views X Radiology Diagnostic 73020 Radiologic examination, shoulder; 1 view X Radiology Diagnostic 73010 Radiologic examination; scapula, complete X Radiology Diagnostic 73000 Radiologic examination; clavicle, complete X Radiology Diagnostic 72220 Radiologic examination, sacrum and coccyx, minimum of 2 views X Radiology Diagnostic 72202 Radiologic examination, sacroiliac joints; 3 or more views X Radiology Diagnostic 72200 Radiologic examination, sacroiliac joints; less than 3 views X Radiology Diagnostic 72190 Radiologic examination, pelvis; complete, minimum of 3 views X Radiology Diagnostic 72170 Radiologic examination, pelvis; 1 or 2 views X Radiology Diagnostic 72120 Radiologic examination, spine, lumbosacral; bending views only, 2 or 3 views X Radiology Diagnostic 72114 Radiologic examination, spine, lumbosacral; complete, including bending views, minimum of 6 views X Radiology Diagnostic 72110 Radiologic examination, spine, lumbosacral; minimum of 4 views X Radiology Diagnostic 72100 Radiologic examination, spine, lumbosacral; 2 or 3 views X Radiology Diagnostic Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed 72084 X Radiology (eg, scoliosis evaluation); minimum of 6 views Diagnostic Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed 72083 X Radiology (eg, scoliosis evaluation); 4 or 5 views Diagnostic Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed 72082 X Radiology (eg, scoliosis evaluation); 2 or 3 views Diagnostic Radiologic examination, spine, entire thoracic and lumbar, including skull, cervical and sacral spine if performed 72081 X Radiology (eg, scoliosis evaluation); one view Diagnostic 72080 Radiologic examination, spine; thoracolumbar junction, minimum of 2 views X Radiology Diagnostic 72074 Radiologic examination, spine; thoracic, minimum of 4 views X Radiology

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Diagnostic 72072 Radiologic examination, spine; thoracic, 3 views X Radiology Diagnostic 72070 Radiologic examination, spine; thoracic, 2 views X Radiology Diagnostic 72052 Radiologic examination, spine, cervical; 6 or more views X Radiology Diagnostic 72050 Radiologic examination, spine, cervical; 4 or 5 views X Radiology Diagnostic 72040 Radiologic examination, spine, cervical; 2 or 3 views X Radiology Diagnostic 72020 Radiologic examination, spine, single view, specify level X Radiology Diagnostic 71130 Radiologic examination; sternoclavicular joint or joints, minimum of 3 views X Radiology Diagnostic 71120 Radiologic examination; sternum, minimum of 2 views X Radiology Diagnostic 71111 Radiologic examination, ribs, bilateral; including posteroanterior chest, minimum of 4 views X Radiology Diagnostic 71110 Radiologic examination, ribs, bilateral; 3 views X Radiology Diagnostic 71101 Radiologic examination, ribs, unilateral; including posteroanterior chest, minimum of 3 views X Radiology Diagnostic 71100 Radiologic examination, ribs, unilateral; 2 views X Radiology Diagnostic 70380 Radiologic examination, salivary gland for calculus X Radiology Diagnostic 70371 Complex dynamic pharyngeal and speech evaluation by cine or video recording X Radiology Diagnostic 70370 Radiologic examination; pharynx or larynx, including and/or magnification technique X Radiology Diagnostic 70360 Radiologic examination; neck, soft tissue X Radiology Diagnostic 70355 Orthopantogram (eg, panoramic x-ray) X Radiology Diagnostic 70350 Cephalogram, orthodontic X Radiology Diagnostic 70330 Radiologic examination, temporomandibular joint, open and closed mouth; bilateral X Radiology

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Diagnostic 70328 Radiologic examination, temporomandibular joint, open and closed mouth; unilateral X Radiology Diagnostic 70320 Radiologic examination, teeth; complete, full mouth X Radiology Diagnostic 70310 Radiologic examination, teeth; partial examination, less than full mouth X Radiology Diagnostic 70300 Radiologic examination, teeth; single view X Radiology Diagnostic 70260 Radiologic examination, skull; complete, minimum of 4 views X Radiology Diagnostic 70250 Radiologic examination, skull; less than 4 views X Radiology Diagnostic 70240 Radiologic examination, sella turcica X Radiology Diagnostic 70220 Radiologic examination, sinuses, paranasal, complete, minimum of 3 views X Radiology Diagnostic 70210 Radiologic examination, sinuses, paranasal, less than 3 views X Radiology Diagnostic 70200 Radiologic examination; orbits, complete, minimum of 4 views X Radiology Diagnostic 70190 Radiologic examination; optic foramina X Radiology Diagnostic 70170 Dacryocystography, nasolacrimal duct, radiological supervision and interpretation X Radiology Diagnostic 70160 Radiologic examination, nasal bones, complete, minimum of 3 views X Radiology Diagnostic 70150 Radiologic examination, facial bones; complete, minimum of 3 views X Radiology Diagnostic 70140 Radiologic examination, facial bones; less than 3 views X Radiology Diagnostic 70134 Radiologic examination, internal auditory meati, complete X Radiology Diagnostic 70130 Radiologic examination, mastoids; complete, minimum of 3 views per side X Radiology Diagnostic 70120 Radiologic examination, mastoids; less than 3 views per side X Radiology Diagnostic 70110 Radiologic examination, mandible; complete, minimum of 4 views X Radiology

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Diagnostic 70100 Radiologic examination, mandible; partial, less than 4 views X Radiology Diagnostic 70030 Radiologic examination, eye, for detection of foreign body X Radiology Diagnostic 70015 Hell X Radiology Diagnostic 70010 , posterior fossa, radiological supervision and interpretation X Radiology Diagnostic Radiopharmaceuti Q9983 Florbetaben F18, diagnostic, per study dose, up to 8.1 millicuries X cal Diagnostic Radiopharmaceuti Q9982 Flutemetamol F18, diagnostic, per study dose, up to 5 millicuries X cal

Fluoroscopic guidance for central venous access device placement, replacement (catheter only or complete), or removal (includes fluoroscopic guidance for vascular access and catheter manipulation, any necessary contrast Fluoroscopy 77001 X injections through access site or catheter with related radiologic supervision and interpretation, and radiographic documentation of final catheter position) (List separately in addition to code for primary procedure)

Fluoroscopy, physician or other qualified health care professional time more than 1 hour, assisting a nonradiologic Fluoroscopy 76001 physician or other qualified health care professional (eg, nephrostolithotomy, ERCP, bronchoscopy, transbronchial X biopsy) Fluoroscopy, (separate procedure), up to 1 hour, up to 1 hour physician or other qualified health care professional Fluoroscopy 76000 Y time Fluoroscopy 74740 , radiological supervision and interpretation X Therapeutic enema, contrast or air, for reduction of intussusception or other intraluminal obstruction (eg, meconium Fluoroscopy 74283 X ileus) Fluoroscopy 74280 Radiologic examination, colon; air contrast with specific high density barium, with or without glucagon X Fluoroscopy 74270 Radiologic examination, colon; contrast (eg, barium) enema, with or without KUB X Fluoroscopy 74251 Radiologic examination, small intestine, includes multiple serial images; via enteroclysis tube X Fluoroscopy 74250 Radiologic examination, small intestine, includes multiple serial images; X Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, effervescent Fluoroscopy 74247 X agent, with or without glucagon; with or without delayed images, with KUB Radiological examination, gastrointestinal tract, upper, air contrast, with specific high density barium, effervescent Fluoroscopy 74246 X agent, with or without glucagon; with or without delayed images, without KUB

Fluoroscopy 74245 Radiologic examination, gastrointestinal tract, upper; with small intestine, includes multiple serial images X

Fluoroscopy 74241 Radiologic examination, gastrointestinal tract, upper; with or without delayed images, with KUB X

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Fluoroscopy 74240 Radiologic examination, gastrointestinal tract, upper; with or without delayed images, without KUB X Fluoroscopy 74230 Swallowing function, with cineradiography/videoradiography X

Radiological guidance (ie, fluoroscopy, ultrasound, or computed tomography), for percutaneous drainage (eg, Interventional S&I 75989 X abscess, specimen collection), with placement of catheter, radiological supervision and interpretation Change of percutaneous tube or drainage catheter with contrast monitoring (eg, genitourinary system, abscess), Interventional S&I 75984 X radiological supervision and interpretation

Interventional S&I 75970 Transcatheter biopsy, radiological supervision and interpretation X Angiography through existing catheter for follow-up study for transcatheter therapy, embolization or infusion, other Interventional S&I 75898 X than for thrombolysis

Interventional S&I 75894 Transcatheter therapy, embolization, any method, radiological supervision and interpretation X Venous sampling through catheter, with or without angiography (eg, for parathyroid hormone, renin), radiological Interventional S&I 75893 X supervision and interpretation

Interventional S&I 75891 Hepatic venography, wedged or free, without hemodynamic evaluation, radiological supervision and interpretation X

Interventional S&I 75889 Hepatic venography, wedged or free, with hemodynamic evaluation, radiological supervision and interpretation X Percutaneous transhepatic portography without hemodynamic evaluation, radiological supervision and Interventional S&I 75887 X interpretation

Interventional S&I 75885 Percutaneous transhepatic portography with hemodynamic evaluation, radiological supervision and interpretation X

Interventional S&I 75880 Venography, orbital, radiological supervision and interpretation X

Interventional S&I 75872 Venography, epidural, radiological supervision and interpretation X

Interventional S&I 75870 Venography, superior sagittal sinus, radiological supervision and interpretation X Venography, venous sinus (eg, petrosal and inferior sagittal) or jugular, catheter, radiological supervision and Interventional S&I 75860 X interpretation

Interventional S&I 75842 Venography, adrenal, bilateral, selective, radiological supervision and interpretation X

Interventional S&I 75840 Venography, adrenal, unilateral, selective, radiological supervision and interpretation X

Interventional S&I 75833 Venography, renal, bilateral, selective, radiological supervision and interpretation X

Interventional S&I 75831 Venography, renal, unilateral, selective, radiological supervision and interpretation X

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management

Interventional S&I 75827 Venography, caval, superior, with serialography, radiological supervision and interpretation X

Interventional S&I 75825 Venography, caval, inferior, with serialography, radiological supervision and interpretation X

Interventional S&I 75822 Venography, extremity, bilateral, radiological supervision and interpretation X

Interventional S&I 75820 Venography, extremity, unilateral, radiological supervision and interpretation X

Interventional S&I 75810 Splenoportography, radiological supervision and interpretation X Shuntogram for investigation of previously placed indwelling nonvascular shunt (eg, LeVeen shunt, Interventional S&I 75809 X ventriculoperitoneal shunt, indwelling infusion pump), radiological supervision and interpretation

Interventional S&I 75807 Lymphangiography, pelvic/abdominal, bilateral, radiological supervision and interpretation X

Interventional S&I 75805 Lymphangiography, pelvic/abdominal, unilateral, radiological supervision and interpretation X

Interventional S&I 75803 Lymphangiography, extremity only, bilateral, radiological supervision and interpretation X

Interventional S&I 75801 Lymphangiography, extremity only, unilateral, radiological supervision and interpretation X Angiography, selective, each additional vessel studied after basic examination, radiological supervision and Interventional S&I 75774 X interpretation (List separately in addition to code for primary procedure)

Interventional S&I 75756 Angiography, internal mammary, radiological supervision and interpretation X

Interventional S&I 75746 Angiography, pulmonary, by nonselective catheter or venous injection, radiological supervision and interpretation X

Interventional S&I 75743 Angiography, pulmonary, bilateral, selective, radiological supervision and interpretation X

Interventional S&I 75741 Angiography, pulmonary, unilateral, selective, radiological supervision and interpretation X

Interventional S&I 75736 Angiography, pelvic, selective or supraselective, radiological supervision and interpretation X

Interventional S&I 75733 Angiography, adrenal, bilateral, selective, radiological supervision and interpretation X

Interventional S&I 75731 Angiography, adrenal, unilateral, selective, radiological supervision and interpretation X Angiography, visceral, selective or supraselective (with or without flush aortogram), radiological supervision and Interventional S&I 75726 X interpretation

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management

Interventional S&I 75716 Angiography, extremity, bilateral, radiological supervision and interpretation X

Interventional S&I 75710 Angiography, extremity, unilateral, radiological supervision and interpretation X

Interventional S&I 75705 Angiography, spinal, selective, radiological supervision and interpretation X

Interventional S&I 75658 Angiography, brachial, retrograde, radiological supervision and interpretation X , abdominal plus bilateral iliofemoral lower extremity, catheter, by serialography, radiological Interventional S&I 75630 X supervision and interpretation

Interventional S&I 75625 Aortography, abdominal, by serialography, radiological supervision and interpretation X

Interventional S&I 75605 Aortography, thoracic, by serialography, radiological supervision and interpretation X

Interventional S&I 75600 Aortography, thoracic, without serialography, radiological supervision and interpretation X

Interventional S&I 74742 Transcervical catheterization of fallopian tube, radiological supervision and interpretation X

Interventional S&I 74485 Dilation of nephrostomy, ureters, or urethra, radiological supervision and interpretation X Radiologic examination, renal cyst study, translumbar, contrast visualization, radiological supervision and Interventional S&I 74470 X interpretation

Interventional S&I 74455 Urethrocystography, voiding, radiological supervision and interpretation X

Interventional S&I 74450 Urethrocystography, retrograde, radiological supervision and interpretation X

Interventional S&I 74445 Corpora cavernosography, radiological supervision and interpretation X

Interventional S&I 74440 Vasography, vesiculography, or epididymography, radiological supervision and interpretation X

Interventional S&I 74430 , minimum of 3 views, radiological supervision and interpretation X

Interventional S&I 74425 Urography, antegrade (pyelostogram, nephrostogram, loopogram), radiological supervision and interpretation X Percutaneous transhepatic dilation of biliary duct stricture with or without placement of stent, radiological Interventional S&I 74363 X supervision and interpretation

Interventional S&I 74360 Intraluminal dilation of strictures and/or obstructions (eg, esophagus), radiological supervision and interpretation X

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management

Interventional S&I 74355 Percutaneous placement of enteroclysis tube, radiological supervision and interpretation X Introduction of long gastrointestinal tube (eg, Miller-Abbott), including multiple fluoroscopies and images, Interventional S&I 74340 X radiological supervision and interpretation Combined endoscopic catheterization of the biliary and pancreatic ductal systems, radiological supervision and Interventional S&I 74330 X interpretation

Interventional S&I 74329 Endoscopic catheterization of the pancreatic ductal system, radiological supervision and interpretation X

Interventional S&I 74328 Endoscopic catheterization of the biliary ductal system, radiological supervision and interpretation X

Interventional S&I 74235 Removal of foreign body(s), esophageal, with use of balloon catheter, radiological supervision and interpretation X

Interventional S&I 73615 Radiologic examination, ankle, arthrography, radiological supervision and interpretation X

Interventional S&I 73580 Radiologic examination, knee, arthrography, radiological supervision and interpretation X

Interventional S&I 73525 Radiologic examination, hip, arthrography, radiological supervision and interpretation X

Interventional S&I 73115 Radiologic examination, wrist, arthrography, radiological supervision and interpretation X

Interventional S&I 73085 Radiologic examination, elbow, arthrography, radiological supervision and interpretation X

Interventional S&I 73040 Radiologic examination, shoulder, arthrography, radiological supervision and interpretation X Myelography, 2 or more regions (eg, lumbar/thoracic, cervical/thoracic, lumbar/cervical, lumbar/thoracic/cervical), Interventional S&I 72270 X radiological supervision and interpretation

Interventional S&I 72265 Myelography, lumbosacral, radiological supervision and interpretation X

Interventional S&I 72255 Myelography, thoracic, radiological supervision and interpretation X

Interventional S&I 72240 Myelography, cervical, radiological supervision and interpretation X

Interventional S&I 70390 , radiological supervision and interpretation X Interventional 70332 Temporomandibular joint arthrography, radiological supervision and interpretation X S&I Injection procedure for radiopharmaceutical localization by non-imaging probe study, intravenous (eg, parathyroid Interventional Rad 78808 X adenoma)

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Endovascular repair of iliac artery aneurysm, pseudoaneurysm, arteriovenous malformation, or trauma, using ilio- Interventional Rad 75954 X iliac tube endoprosthesis, radiological supervision and interpretation Placement of proximal or distal extension prosthesis for endovascular repair of infrarenal aortic or iliac artery Interventional Rad 75953 X aneurysm, pseudoaneurysm, or dissection, radiological supervision and interpretation Endovascular repair of infrarenal abdominal aortic aneurysm or dissection, radiological supervision and Interventional Rad 75952 X interpretation Mechanical removal of intraluminal (intracatheter) obstructive material from central venous device through device Interventional Rad 75902 X lumen, radiologic supervision and interpretation Mechanical removal of pericatheter obstructive material (eg, fibrin sheath) from central venous device via separate Interventional Rad 75901 X venous access, radiologic supervision and interpretation Mammogrpahy G0206 Diagnostic , producing direct 2-d digital image, unilateral, all views X Mammogrpahy G0204 Diagnostic mammography, producing direct 2-d digital image, bilateral, all views X Mammogrpahy G0202 Screening mammography, producing direct digital image, bilateral, all views X Screening mammography, bilateral (2-view study of each breast), including computer-aided detection (CAD) when Mammogrpahy 77067 X performed Mammogrpahy 77066 Diagnostic mammography, including computer-aided detection (CAD) when performed; bilateral X Mammogrpahy 77065 Diagnostic mammography, including computer-aided detection (CAD) when performed; unilateral X

Mammogrpahy 77063 Screening digital breast tomosynthesis, bilateral (List separately in addition to code for primary procedure) X

Mammogrpahy 77062 Digital breast tomosynthesis; bilateral X Mammogrpahy 77061 Digital breast tomosynthesis; unilateral X Mammogrpahy 77054 Mammary ductogram or galactogram, multiple ducts, radiological supervision and interpretation X Mammogrpahy 77053 Mammary ductogram or galactogram, single duct, radiological supervision and interpretation X Mammogrpahy 76140 Consultation on X-ray examination made elsewhere, written report X

Magnetic resonance image guided high intensity focused ultrasound (MRgFUS), stereotactic ablation lesion, MR 0398T X intracranial for movement disorder including stereotactic navigation and frame placement when performed

MR 77084 Magnetic resonance (eg, proton) imaging, bone marrow blood supply X MR 77022 Magnetic resonance imaging guidance for, and monitoring of, parenchymal tissue ablation X Magnetic resonance imaging guidance for needle placement (eg, for biopsy, needle aspiration, injection, or MR 77021 X placement of localization device) radiological supervision and interpretation MR 76498 Unlisted magnetic resonance procedure (eg, diagnostic, interventional) X MR 76390 Magnetic resonance spectroscopy X Cardiac magnetic resonance imaging for velocity flow mapping (List separately in addition to code for primary MR 75565 X procedure)

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast MR 75563 X material(s) and further sequences; with stress imaging Cardiac magnetic resonance imaging for morphology and function without contrast material(s), followed by contrast MR 75561 X material(s) and further sequences;

MR 75559 Cardiac magnetic resonance imaging for morphology and function without contrast material; with stress imaging X

MR 75557 Cardiac magnetic resonance imaging for morphology and function without contrast material; X Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; MR 74713 X each additional gestation (List separately in addition to code for primary procedure) Magnetic resonance (eg, proton) imaging, fetal, including placental and maternal pelvic imaging when performed; MR 74712 X single or first gestation MR 74185 Magnetic resonance angiography, abdomen, with or without contrast material(s) X Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s), followed by with contrast MR 74183 X material(s) and further sequences MR 74182 Magnetic resonance (eg, proton) imaging, abdomen; with contrast material(s) X MR 74181 Magnetic resonance (eg, proton) imaging, abdomen; without contrast material(s) X MR 73725 Magnetic resonance angiography, lower extremity, with or without contrast material(s) X Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material(s), followed by MR 73723 X contrast material(s) and further sequences MR 73722 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; with contrast material(s) X MR 73721 Magnetic resonance (eg, proton) imaging, any joint of lower extremity; without contrast material X Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s), followed by MR 73720 X contrast material(s) and further sequences MR 73719 Magnetic resonance (eg, proton) imaging, lower extremity other than joint; with contrast material(s) X MR 73718 Magnetic resonance (eg, proton) imaging, lower extremity other than joint; without contrast material(s) X MR 73225 Magnetic resonance angiography, upper extremity, with or without contrast material(s) X Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s), followed by MR 73223 X contrast material(s) and further sequences MR 73222 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; with contrast material(s) X MR 73221 Magnetic resonance (eg, proton) imaging, any joint of upper extremity; without contrast material(s) X Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s), followed by MR 73220 X contrast material(s) and further sequences MR 73219 Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; with contrast material(s) X

MR 73218 Magnetic resonance (eg, proton) imaging, upper extremity, other than joint; without contrast material(s) X

MR 72198 Magnetic resonance angiography, pelvis, with or without contrast material(s) X

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s), followed by contrast material(s) and MR 72197 X further sequences MR 72196 Magnetic resonance (eg, proton) imaging, pelvis; with contrast material(s) X MR 72195 Magnetic resonance (eg, proton) imaging, pelvis; without contrast material(s) X MR 72159 Magnetic resonance angiography, spinal canal and contents, with or without contrast material(s) X Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast MR 72158 X material(s) and further sequences; lumbar Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast MR 72157 X material(s) and further sequences; thoracic Magnetic resonance (eg, proton) imaging, spinal canal and contents, without contrast material, followed by contrast MR 72156 X material(s) and further sequences; cervical

MR 72149 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; with contrast material(s) X

MR 72148 Magnetic resonance (eg, proton) imaging, spinal canal and contents, lumbar; without contrast material X

MR 72147 Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; with contrast material(s) X

MR 72146 Magnetic resonance (eg, proton) imaging, spinal canal and contents, thoracic; without contrast material X

MR 72142 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; with contrast material(s) X

MR 72141 Magnetic resonance (eg, proton) imaging, spinal canal and contents, cervical; without contrast material X

MR 71555 Magnetic resonance angiography, chest (excluding myocardium), with or without contrast material(s) X

Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); MR 71552 X without contrast material(s), followed by contrast material(s) and further sequences Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); with MR 71551 X contrast material(s) Magnetic resonance (eg, proton) imaging, chest (eg, for evaluation of hilar and mediastinal lymphadenopathy); MR 71550 X without contrast material(s) Magnetic resonance imaging, brain, functional MRI; requiring physician or psychologist administration of entire MR 70555 X neurofunctional testing Magnetic resonance imaging, brain, functional MRI; including test selection and administration of repetitive body MR 70554 X part movement and/or visual stimulation, not requiring physician or psychologist administration Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material, followed by MR 70553 X contrast material(s) and further sequences

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management MR 70552 Magnetic resonance (eg, proton) imaging, brain (including brain stem); with contrast material(s) X MR 70551 Magnetic resonance (eg, proton) imaging, brain (including brain stem); without contrast material X Magnetic resonance angiography, neck; without contrast material(s), followed by contrast material(s) and further MR 70549 X sequences MR 70548 Magnetic resonance angiography, neck; with contrast material(s) X MR 70547 Magnetic resonance angiography, neck; without contrast material(s) X Magnetic resonance angiography, head; without contrast material(s), followed by contrast material(s) and further MR 70546 X sequences MR 70545 Magnetic resonance angiography, head; with contrast material(s) X MR 70544 Magnetic resonance angiography, head; without contrast material(s) X Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s), followed by contrast MR 70543 X material(s) and further sequences MR 70542 Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; with contrast material(s) X MR 70540 Magnetic resonance (eg, proton) imaging, orbit, face, and/or neck; without contrast material(s) X MR 70336 Magnetic resonance (eg, proton) imaging, temporomandibular joint(s) X MRI 76391 Magnetic resonance (eg, vibration) x Myocardial strain imaging (quantitative assessment of myocardial mechanics using image-based analysis of local 0399T X myocardial dynamics) (List separately in addition to code for primary procedure)

Nuclear Medicine 78807 Radiopharmaceutical localization of inflammatory process; tomographic (SPECT) X

Nuclear Medicine 78806 Radiopharmaceutical localization of inflammatory process; whole body X

Nuclear Medicine 78805 Radiopharmaceutical localization of inflammatory process; limited area X Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) Nuclear Medicine 78804 (includes vascular flow and blood pool imaging, when performed); planar, whole body, requiring 2 or more days X imaging Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) Nuclear Medicine 78803 (includes vascular flow and blood pool imaging, when performed); tomographic (SPECT) , single area (eg, head, X neck, chest, pelvis), single day imaging

Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) Nuclear Medicine 78802 X (includes vascular flow and blood pool imaging, when performed); planar, whole body, single day imaging

Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) Nuclear Medicine 78801 (includes vascular flow and blood pool imaging, when performed); planar, 2 or more mulitple areas (eg, abdomen X and pelvis, head and chest), 1 or more days imaging or single area imaging over 2 or more days

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Radiopharmaceutical localization of tumor, inflammatory process or distribution of radiopharmaceutical agent(s) (includes vascular flow and blood pool imaging, when performed); planar, single limited area (includes vascular Nuclear Medicine 78800 X flow and blood pool imaging, when performed); planar, single (includes vascular flow and blood pool imaging, when performed); planar, single

Nuclear Medicine 78761 Testicular imaging with vascular flow X

Nuclear Medicine 78740 Ureteral reflux study (radiopharmaceutical voiding cystogram) X

Nuclear Medicine 78730 Urinary bladder residual study (List separately in addition to code for primary procedure) X

Nuclear Medicine 78725 Kidney function study, non-imaging radioisotopic study X

Nuclear Medicine 78710 Kidney imaging morphology; tomographic (SPECT) X Kidney imaging morphology; with vascular flow and function, multiple studies, with and without pharmacological Nuclear Medicine 78709 X intervention (eg, angiotensin converting enzyme inhibitor and/or diuretic) Kidney imaging morphology; with vascular flow and function, single study, with pharmacological intervention (eg, Nuclear Medicine 78708 X angiotensin converting enzyme inhibitor and/or diuretic)

Nuclear Medicine 78707 Kidney imaging morphology; with vascular flow and function, single study without pharmacological intervention X

Nuclear Medicine 78701 Kidney imaging morphology; with vascular flow X

Nuclear Medicine 78700 Kidney imaging morphology; X

Nuclear Medicine 78660 Radiopharmaceutical dacryocystography X

Nuclear Medicine 78650 Cerebrospinal fluid leakage detection and localization X

Nuclear Medicine 78647 Cerebrospinal fluid flow, imaging (not including introduction of material); tomographic (SPECT) X

Nuclear Medicine 78645 Cerebrospinal fluid flow, imaging (not including introduction of material); shunt evaluation X

Nuclear Medicine 78635 Cerebrospinal fluid flow, imaging (not including introduction of material); ventriculography X

Nuclear Medicine 78630 Cerebrospinal fluid flow, imaging (not including introduction of material); cisternography X

Nuclear Medicine 78610 Brain imaging, vascular flow only X

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management

Nuclear Medicine 78607 Brain imaging, tomographic (SPECT) X

Nuclear Medicine 78606 Brain imaging, minimum 4 static views; with vascular flow X

Nuclear Medicine 78605 Brain imaging, minimum 4 static views; X

Nuclear Medicine 78601 Brain imaging, less than 4 static views; with vascular flow X

Nuclear Medicine 78600 Brain imaging, less than 4 static views; X

Nuclear Medicine 78598 Quantitative differential pulmonary perfusion and ventilation (eg, aerosol or gas), including imaging when performed X

Nuclear Medicine 78597 Quantitative differential pulmonary perfusion, including imaging when performed X

Nuclear Medicine 78582 Pulmonary ventilation (eg, aerosol or gas) and perfusion imaging X

Nuclear Medicine 78580 Pulmonary perfusion imaging (eg, particulate) X

Nuclear Medicine 78579 Pulmonary ventilation imaging (eg, aerosol or gas) X

Nuclear Medicine 78499 Unlisted cardiovascular procedure, diagnostic nuclear medicine X Cardiac blood pool imaging, gated equilibrium, single study, at rest, with right ventricular ejection fraction by first Nuclear Medicine 78496 X pass technique (List separately in addition to code for primary procedure) Cardiac blood pool imaging, gated equilibrium, SPECT, at rest, wall motion study plus ejection fraction, with or Nuclear Medicine 78494 X without quantitative processing Myocardial imaging, positron emission tomography (PET), perfusion study(including ventricular wall motion[s] Nuclear Medicine 78492 X and/or ejection fraction[s], when performed); multiple studies at rest and/or stress (exercise or pharmacologic)

Myocardial imaging, positron emission tomography (PET), perfusion study(including ventricular wall motion[s] Nuclear Medicine 78491 X and/or ejection fraction[s], when performed); single study, at rest or stress (exercise or pharmacologic) Cardiac blood pool imaging (planar), first pass technique; multiple studies, at rest and with stress (exercise and/or Nuclear Medicine 78483 X pharmacologic), wall motion study plus ejection fraction, with or without quantification Cardiac blood pool imaging (planar), first pass technique; single study, at rest or with stress (exercise and/or Nuclear Medicine 78481 X pharmacologic), wall motion study plus ejection fraction, with or without quantification Cardiac blood pool imaging, gated equilibrium; multiple studies, wall motion study plus ejection fraction, at rest and Nuclear Medicine 78473 X stress (exercise and/or pharmacologic), with or without additional quantification

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management

Cardiac blood pool imaging, gated equilibrium; planar, single study at rest or stress (exercise and/or Nuclear Medicine 78472 X pharmacologic), wall motion study plus ejection fraction, with or without additional quantitative processing

Nuclear Medicine 78469 Myocardial imaging, infarct avid, planar; tomographic SPECT with or without quantification X

Nuclear Medicine 78468 Myocardial imaging, infarct avid, planar; with ejection fraction by first pass technique X

Nuclear Medicine 78466 Myocardial imaging, infarct avid, planar; qualitative or quantitative X Myocardial imaging, positron emission tomography (PET), metabolic evaluation study (including ventricular wall Nuclear Medicine 78459 X motion[s] and/or ejection fraction[s], when performed), single study

Nuclear Medicine 78458 Venous thrombosis imaging, venogram; bilateral X

Nuclear Medicine 78457 Venous thrombosis imaging, venogram; unilateral X

Nuclear Medicine 78456 Acute venous thrombosis imaging, peptide X Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass Nuclear Medicine 78454 or gated technique, additional quantification, when performed); multiple studies, at rest and/or stress (exercise or X pharmacologic) and/or redistribution and/or rest reinjection Myocardial perfusion imaging, planar (including qualitative or quantitative wall motion, ejection fraction by first pass Nuclear Medicine 78453 or gated technique, additional quantification, when performed); single study, at rest or stress (exercise or X pharmacologic)

Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative Nuclear Medicine 78452 wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); multiple X studies, at rest and/or stress (exercise or pharmacologic) and/or redistribution and/or rest reinjection

Myocardial perfusion imaging, tomographic (SPECT) (including attenuation correction, qualitative or quantitative Nuclear Medicine 78451 wall motion, ejection fraction by first pass or gated technique, additional quantification, when performed); single X study, at rest or stress (exercise or pharmacologic)

Nuclear Medicine 78445 Non-cardiac vascular flow imaging (ie, angiography, venography) X

Nuclear Medicine 78428 Cardiac shunt detection X Determination of central c-v (non-imaging) (eg, ejection fraction with probe technique) with or Nuclear Medicine 78414 X without pharmacologic intervention or exercise, single or multiple determinations

Nuclear Medicine 78351 Bone density (bone mineral content) study, 1 or more sites; dual photon absorptiometry, 1 or more sites X

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management

Nuclear Medicine 78350 Bone density (bone mineral content) study, 1 or more sites; single photon absorptiometry X

Nuclear Medicine 78320 Bone and/or joint imaging; tomographic (SPECT) X

Nuclear Medicine 78315 Bone and/or joint imaging; 3 phase study X

Nuclear Medicine 78306 Bone and/or joint imaging; whole body X

Nuclear Medicine 78305 Bone and/or joint imaging; multiple areas X

Nuclear Medicine 78300 Bone and/or joint imaging; limited area X

Nuclear Medicine 78291 Peritoneal-venous shunt patency test (eg, for LeVeen, Denver shunt) X

Nuclear Medicine 78290 Intestine imaging (eg, ectopic gastric mucosa, Meckel's localization, volvulus) X

Nuclear Medicine 78282 Gastrointestinal protein loss X

Nuclear Medicine 78278 Acute gastrointestinal blood loss imaging X

Nuclear Medicine 78272 Vitamin B-12 absorption studies combined, with and without intrinsic factor X

Nuclear Medicine 78271 Vitamin B-12 absorption study (eg, Schilling test); with intrinsic factor X

Nuclear Medicine 78270 Vitamin B-12 absorption study (eg, Schilling test); without intrinsic factor X

Nuclear Medicine 78268 Urea breath test, C-14 (isotopic); analysis X

Nuclear Medicine 78267 Urea breath test, C-14 (isotopic); acquisition for analysis X

Nuclear Medicine 78266 Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel and colon transit, multiple days X

Nuclear Medicine 78265 Gastric emptying imaging study (eg, solid, liquid, or both); with small bowel transit X

Nuclear Medicine 78264 Gastric emptying imaging study (eg, solid, liquid, or both); X

Nuclear Medicine 78262 Gastroesophageal reflux study X

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management

Nuclear Medicine 78261 Gastric mucosa imaging X

Nuclear Medicine 78258 Esophageal motility X

Nuclear Medicine 78232 Salivary gland function study X

Nuclear Medicine 78231 Salivary gland imaging; with serial images X

Nuclear Medicine 78230 Salivary gland imaging; X Hepatobiliary system imaging, including gallbladder when present; with pharmacologic intervention, including Nuclear Medicine 78227 X quantitative measurement(s) when performed

Nuclear Medicine 78226 Hepatobiliary system imaging, including gallbladder when present; X

Nuclear Medicine 78216 Liver and spleen imaging; with vascular flow X

Nuclear Medicine 78215 Liver and spleen imaging; static only X

Nuclear Medicine 78206 Liver imaging (SPECT); with vascular flow X

Nuclear Medicine 78205 Liver imaging (SPECT); X

Nuclear Medicine 78202 Liver imaging; with vascular flow X

Nuclear Medicine 78201 Liver imaging; static only X

Nuclear Medicine 78195 Lymphatics and lymph nodes imaging X

Nuclear Medicine 78185 Spleen imaging only, with or without vascular flow X

Nuclear Medicine 78140 Labeled red cell sequestration, differential organ/tissue (eg, splenic and/or hepatic) X

Nuclear Medicine 78135 Red cell survival study; differential organ/tissue kinetics (eg, splenic and/or hepatic sequestration) X

Nuclear Medicine 78130 Red cell survival study; X Whole blood volume determination, including separate measurement of plasma volume and red cell volume Nuclear Medicine 78122 X (radiopharmaceutical volume-dilution technique)

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management

Nuclear Medicine 78121 Red cell volume determination (separate procedure); multiple samplings X

Nuclear Medicine 78120 Red cell volume determination (separate procedure); single sampling X

Nuclear Medicine 78111 Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); multiple samplings X

Nuclear Medicine 78110 Plasma volume, radiopharmaceutical volume-dilution technique (separate procedure); single sampling X

Nuclear Medicine 78104 Bone marrow imaging; whole body X

Nuclear Medicine 78103 Bone marrow imaging; multiple areas X

Nuclear Medicine 78102 Bone marrow imaging; limited area X

Nuclear Medicine 78075 Adrenal imaging, cortex and/or medulla X Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT), and concurrently Nuclear Medicine 78072 X acquired computed tomography (CT) for anatomical localization

Nuclear Medicine 78071 Parathyroid planar imaging (including subtraction, when performed); with tomographic (SPECT) X

Nuclear Medicine 78070 Parathyroid planar imaging (including subtraction, when performed); X

Nuclear Medicine 78020 Thyroid carcinoma metastases uptake (List separately in addition to code for primary procedure) X

Nuclear Medicine 78018 Thyroid carcinoma metastases imaging; whole body X

Nuclear Medicine 78016 Thyroid carcinoma metastases imaging; with additional studies (eg, urinary recovery) X

Nuclear Medicine 78015 Thyroid carcinoma metastases imaging; limited area (eg, neck and chest only) X Thyroid imaging (including vascular flow, when performed); with single or multiple uptake(s) quantitative Nuclear Medicine 78014 X measurement(s) (including stimulation, suppression, or discharge, when performed)

Nuclear Medicine 78013 Thyroid imaging (including vascular flow, when performed); X Thyroid uptake, single or multiple quantitative measurement(s) (including stimulation, suppression, or discharge, Nuclear Medicine 78012 X when performed)

Nuclear Medicine 78191 Platelet survival study X

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Pet imaging, full and partial-ring pet scanners only, for initial diagnosis of breast cancer and/or surgical planning for PET G0252 X breast cancer (e.g., initial staging of axillary lymph nodes) PET G0235 Pet imaging, any site, not otherwise specified X PET G0219 Pet imaging whole body; melanoma for non-covered indications X Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation PET 78816 X correction and anatomical localization imaging; whole body Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation PET 78815 X correction and anatomical localization imaging; skull base to mid-thigh Positron emission tomography (PET) with concurrently acquired computed tomography (CT) for attenuation PET 78814 X correction and anatomical localization imaging; limited area (eg, chest, head/neck) PET 78813 Positron emission tomography (PET) imaging; whole body X PET 78812 Positron emission tomography (PET) imaging; skull base to mid-thigh X PET 78811 Positron emission tomography (PET) imaging; limited area (eg, chest, head/neck) X PET 78609 Brain imaging, positron emission tomography (PET); perfusion evaluation X PET 78608 Brain imaging, positron emission tomography (PET); metabolic evaluation X Radioisotope A9700 Supply of injectable contrast material for use in echocardiography, per study X Contrast Radioisotope A9698 Non-radioactive contrast imaging material, not otherwise classified, per study X Contrast Radioisotope A9586 Florbetapir f18, diagnostic, per study dose, up to 10 millicuries X Contrast Radioisotope A9585 Injection, gadobutrol, 0.1 ml X Contrast Radioisotope A9583 Injection, gadofosveset trisodium, 1 ml X Contrast Radioisotope A9582 Iodine i-123 iobenguane, diagnostic, per study dose, up to 15 millicuries X Contrast Radioisotope A9581 Injection, gadoxetate disodium, 1 ml X Contrast Radioisotope A9579 Injection, gadolinium-based magnetic resonance contrast agent, not otherwise specified (nos), per ml X Contrast Radioisotope A9576 Injection, gadoteridol, (prohance multipack), per ml X Contrast Radioisotope A9572 Indium in-111 pentetreotide, diagnostic, per study dose, up to 6 millicuries X Contrast Radioisotope A9571 Indium in-111 labeled autologous platelets, diagnostic, per study dose X Contrast

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Radioisotope A9570 Indium in-111 labeled autologous white blood cells, diagnostic, per study dose X Contrast Radioisotope A9569 Technetium tc-99m exametazime labeled autologous white blood cells, diagnostic, per study dose X Contrast Radioisotope A9568 Technetium tc-99m arcitumomab, diagnostic, per study dose, up to 45 millicuries X Contrast Radioisotope A9567 Technetium tc-99m pentetate, diagnostic, aerosol, per study dose, up to 75 millicuries X Contrast Radioisotope A9566 Technetium tc-99m fanolesomab, diagnostic, per study dose, up to 25 millicuries X Contrast Radioisotope A9562 Technetium tc-99m mertiatide, diagnostic, per study dose, up to 15 millicuries X Contrast Radioisotope A9561 Technetium tc-99m oxidronate, diagnostic, per study dose, up to 30 millicuries X Contrast Radioisotope A9560 Technetium tc-99m labeled red blood cells, diagnostic, per study dose, up to 30 millicuries X Contrast Radioisotope A9558 Xenon xe-133 gas, diagnostic, per 10 millicuries X Contrast Radioisotope A9557 Technetium tc-99m bicisate, diagnostic, per study dose, up to 25 millicuries X Contrast Radioisotope A9556 Gallium ga-67 citrate, diagnostic, per millicurie X Contrast Radioisotope A9555 Rubidium rb-82, diagnostic, per study dose, up to 60 millicuries X Contrast Radioisotope A9554 Iodine i-125 sodium iothalamate, diagnostic, per study dose, up to 10 microcuries X Contrast Radioisotope A9553 Chromium cr-51 sodium chromate, diagnostic, per study dose, up to 250 microcuries X Contrast Radioisotope A9552 Fluorodeoxyglucose f-18 fdg, diagnostic, per study dose, up to 45 millicuries X Contrast Radioisotope A9551 Technetium tc-99m succimer, diagnostic, per study dose, up to 10 millicuries X Contrast Radioisotope A9550 Technetium tc-99m sodium gluceptate, diagnostic, per study dose, up to 25 millicurie X Contrast Radioisotope A9548 Indium in-111 pentetate, diagnostic, per 0.5 millicurie X Contrast Radioisotope A9547 Indium in-111 oxyquinoline, diagnostic, per 0.5 millicurie X Contrast

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Radioisotope A9541 Technetium tc-99m sulfur colloid, diagnostic, per study dose, up to 20 millicuries X Contrast Radioisotope A9540 Technetium tc-99m macroaggregated albumin, diagnostic, per study dose, up to 10 millicuries X Contrast Radioisotope A9539 Technetium tc-99m pentetate, diagnostic, per study dose, up to 25 millicuries X Contrast Radioisotope A9538 Technetium tc-99m pyrophosphate, diagnostic, per study dose, up to 25 millicuries X Contrast Radioisotope A9537 Technetium tc-99m mebrofenin, diagnostic, per study dose, up to 15 millicuries X Contrast Radioisotope A9536 Technetium tc-99m depreotide, diagnostic, per study dose, up to 35 millicuries X Contrast Radioisotope A9532 Iodine i-125 serum albumin, diagnostic, per 5 microcuries X Contrast Radioisotope A9531 Iodine i-131 sodium iodide, diagnostic, per microcurie (up to 100 microcuries) X Contrast Radioisotope A9529 Iodine i-131 sodium iodide solution, diagnostic, per millicurie X Contrast Radioisotope A9528 Iodine i-131 sodium iodide capsule(s), diagnostic, per millicurie X Contrast Radioisotope A9526 Nitrogen n-13 ammonia, diagnostic, per study dose, up to 40 millicuries X Contrast Radioisotope A9524 Iodine i-131 iodinated serum albumin, diagnostic, per 5 microcuries X Contrast Radioisotope A9521 Technetium tc-99m exametazime, diagnostic, per study dose, up to 25 millicuries X Contrast Radioisotope A9520 Technetium tc-99m tilmanocept, diagnostic, up to 0.5 millicuries X Contrast Radioisotope A9516 Iodine i-123 sodium iodide, diagnostic, per 100 microcuries, up to 999 microcuries X Contrast Radioisotope A9515 Choline C-11, diagnostic, per study dose up to 20 millicuries X Contrast Radioisotope A9512 Technetium tc-99m pertechnetate, diagnostic, per millicurie X Contrast Radioisotope A9510 Technetium tc-99m disofenin, diagnostic, per study dose, up to 15 millicuries X Contrast Radioisotope A9509 Iodine i-123 sodium iodide, diagnostic, per millicurie X Contrast

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Radioisotope A9508 Iodine i-131 iobenguane sulfate, diagnostic, per 0.5 millicurie X Contrast Radioisotope A9507 Indium in-111 capromab pendetide, diagnostic, per study dose, up to 10 millicuries X Contrast Radioisotope A9505 Thallium tl-201 thallous chloride, diagnostic, per millicurie X Contrast Radioisotope A9504 Technetium tc-99m APCitide, diagnostic, per study dose, up to 20 millicuries X Contrast Radioisotope A9503 Technetium tc-99m medronate, diagnostic, per study dose, up to 30 millicuries X Contrast Radioisotope A9502 Technetium tc-99m tetrofosmin, diagnostic, per study dose X Contrast Radioisotope A9501 Technetium tc-99m teboroxime, diagnostic, per study dose X Contrast Radioisotope A9500 Technetium tc-99m sestamibi, diagnostic, per study dose X Contrast Radioisotope A4641 Radiopharmaceutical, diagnostic, not otherwise classified X Contrast

Ultrasound G0389 Ultrasound b-scan and/or real time with image documentation; for abdominal aortic aneurysm (aaa) screening X

Ultrasound 93998 Unlisted noninvasive vascular diagnostic study X Ultrasound 93990 Duplex scan of hemodialysis access (including arterial inflow, body of access and venous outflow) X Ultrasound 93981 Duplex scan of arterial inflow and venous outflow of penile vessels; follow-up or limited study X Ultrasound 93980 Duplex scan of arterial inflow and venous outflow of penile vessels; complete study X Ultrasound 93979 Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; unilateral or limited study X Ultrasound 93978 Duplex scan of aorta, inferior vena cava, iliac vasculature, or bypass grafts; complete study X Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal Ultrasound 93976 X organs; limited study Duplex scan of arterial inflow and venous outflow of abdominal, pelvic, scrotal contents and/or retroperitoneal Ultrasound 93975 X organs; complete study Duplex scan of extremity veins including responses to compression and other maneuvers; unilateral or limited Ultrasound 93971 X study

Ultrasound 93970 Duplex scan of extremity veins including responses to compression and other maneuvers; complete bilateral study X

Ultrasound 93931 Duplex scan of upper extremity arteries or arterial bypass grafts; unilateral or limited study X Ultrasound 93930 Duplex scan of upper extremity arteries or arterial bypass grafts; complete bilateral study X Ultrasound 93926 Duplex scan of lower extremity arteries or arterial bypass grafts; unilateral or limited study X

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Ultrasound 93925 Duplex scan of lower extremity arteries or arterial bypass grafts; complete bilateral study X Noninvasive physiologic studies of lower extremity arteries, at rest and following treadmill stress testing, (ie, bidirectional Doppler waveform or volume plethysmography recording and analysis at rest with ankle/brachial Ultrasound 93924 indices immediately after and at timed intervals following performance of a standardized protocol on a motorized X treadmill plus recording of time of onset of claudication or other symptoms, maximal walking time, and time to recovery) complete bilateral study

Complete bilateral noninvasive physiologic studies of upper or lower extremity arteries, 3 or more levels (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental blood pressure measurements with bidirectional Doppler waveform recording and analysis, at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental Ultrasound 93923 X volume plethysmography at 3 or more levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus segmental transcutaneous oxygen tension measurements at 3 or more levels), or single level study with provocative functional maneuvers (eg, measurements with postural provocative tests, or measurements with reactive hyperemia)

Limited bilateral noninvasive physiologic studies of upper or lower extremity arteries, (eg, for lower extremity: ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries plus bidirectional, Doppler Ultrasound 93922 waveform recording and analysis at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior X tibial/dorsalis pedis arteries plus volume plethysmography at 1-2 levels, or ankle/brachial indices at distal posterior tibial and anterior tibial/dorsalis pedis arteries with, transcutaneous oxygen tension measurement at 1-2 levels)

Ultrasound 93893 study of the intracranial arteries; emboli detection with intravenous microbubble injection X

Ultrasound 93892 Transcranial Doppler study of the intracranial arteries; emboli detection without intravenous microbubble injection X

Ultrasound 93890 Transcranial Doppler study of the intracranial arteries; vasoreactivity study X Ultrasound 93888 Transcranial Doppler study of the intracranial arteries; limited study X Ultrasound 93886 Transcranial Doppler study of the intracranial arteries; complete study X Ultrasound 93882 Duplex scan of extracranial arteries; unilateral or limited study X Ultrasound 93880 Duplex scan of extracranial arteries; complete bilateral study X Ultrasound 76999 Unlisted ultrasound procedure (eg, diagnostic, interventional) X Ultrasound 76998 Ultrasonic guidance, intraoperative X Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); each additional Ultrasound 76979 x lesion with separate injection (List separately in addition to code for primary procedure)

Ultrasound 76978 Ultrasound, targeted dynamic microbubble sonographic contrast characterization (non-cardiac); initial lesion x

Ultrasound 76975 Gastrointestinal , supervision and interpretation X

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Ultrasound 76970 Ultrasound study follow-up (specify) X Ultrasound 76948 Ultrasonic guidance for aspiration of ova, imaging supervision and interpretation X Ultrasound 76946 Ultrasonic guidance for amniocentesis, imaging supervision and interpretation X Ultrasound 76945 Ultrasonic guidance for chorionic villus sampling, imaging supervision and interpretation X Ultrasonic guidance for needle placement (eg, biopsy, aspiration, injection, localization device), imaging Ultrasound 76942 X supervision and interpretation

Ultrasound 76941 Ultrasonic guidance for intrauterine fetal transfusion or cordocentesis, imaging supervision and interpretation X

Ultrasound 76940 Ultrasound guidance for, and monitoring of, parenchymal tissue ablation X

Ultrasound guidance for vascular access requiring ultrasound evaluation of potential access sites, documentation Ultrasound 76937 of selected vessel patency, concurrent realtime ultrasound visualization of vascular needle entry, with permanent X recording and reporting (List separately in addition to code for primary procedure) Ultrasound guided compression repair of arterial pseudoaneurysm or arteriovenous fistulae (includes diagnostic Ultrasound 76936 X ultrasound evaluation, compression of lesion and imaging) Ultrasound 76932 Ultrasonic guidance for endomyocardial biopsy, imaging supervision and interpretation X Ultrasound 76930 Ultrasonic guidance for , imaging supervision and interpretation X Ultrasound, infant hips, real time with imaging documentation; limited, static (not requiring physician or other Ultrasound 76886 X qualified health care professional manipulation) Ultrasound, infant hips, real time with imaging documentation; dynamic (requiring physician or other qualified health Ultrasound 76885 X care professional manipulation) Ultrasound 76882 Ultrasound, extremity, nonvascular, real-time with image documentation; limited, anatomic specific X Ultrasound 76881 Ultrasound, extremity, nonvascular, real-time with image documentation; complete X

Ultrasound 76873 Ultrasound, transrectal; prostate volume study for brachytherapy treatment planning (separate procedure) X

Ultrasound 76872 Ultrasound, transrectal; X Ultrasound 76870 Ultrasound, scrotum and contents X

Ultrasound 76857 Ultrasound, pelvic (nonobstetric), real time with image documentation; limited or follow-up (eg, for follicles) X

Ultrasound 76856 Ultrasound, pelvic (nonobstetric), real time with image documentation; complete X Ultrasound 76831 Saline infusion sonohysterography (SIS), including color flow Doppler, when performed X Ultrasound 76830 Ultrasound, transvaginal X Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; follow-up or repeat Ultrasound 76828 X study Ultrasound 76827 Doppler echocardiography, fetal, pulsed wave and/or continuous wave with spectral display; complete X

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode Ultrasound 76826 X recording; follow-up or repeat study Echocardiography, fetal, cardiovascular system, real time with image documentation (2D), with or without M-mode Ultrasound 76825 X recording; Ultrasound 76821 Doppler velocimetry, fetal; middle cerebral artery X Ultrasound 76820 Doppler velocimetry, fetal; umbilical artery X Ultrasound 76819 Fetal biophysical profile; without non-stress testing X Ultrasound 76818 Fetal biophysical profile; with non-stress testing X Ultrasound 76817 Ultrasound, pregnant uterus, real time with image documentation, transvaginal X

Ultrasound, pregnant uterus, real time with image documentation, follow-up (eg, re-evaluation of fetal size by Ultrasound 76816 measuring standard growth parameters and amniotic fluid volume, re-evaluation of organ system(s) suspected or X confirmed to be abnormal on a previous scan), transabdominal approach, per fetus Ultrasound, pregnant uterus, real time with image documentation, limited (eg, fetal heart beat, placental location, Ultrasound 76815 X fetal position and/or qualitative amniotic fluid volume), 1 or more fetuses Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency Ultrasound 76814 measurement, transabdominal or transvaginal approach; each additional gestation (List separately in addition to X code for primary procedure) Ultrasound, pregnant uterus, real time with image documentation, first trimester fetal nuchal translucency Ultrasound 76813 X measurement, transabdominal or transvaginal approach; single or first gestation Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal Ultrasound 76812 anatomic examination, transabdominal approach; each additional gestation (List separately in addition to code for X primary procedure) Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation plus detailed fetal Ultrasound 76811 X anatomic examination, transabdominal approach; single or first gestation Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester Ultrasound 76810 (> or = 14 weeks 0 days), transabdominal approach; each additional gestation (List separately in addition to code X for primary procedure) Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, after first trimester Ultrasound 76805 X (> or = 14 weeks 0 days), transabdominal approach; single or first gestation Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 Ultrasound 76802 weeks 0 days), transabdominal approach; each additional gestation (List separately in addition to code for primary X procedure) Ultrasound, pregnant uterus, real time with image documentation, fetal and maternal evaluation, first trimester (< 14 Ultrasound 76801 X weeks 0 days), transabdominal approach; single or first gestation Ultrasound 76800 Ultrasound, spinal canal and contents X Ultrasound 76776 Ultrasound, transplanted kidney, real time and duplex Doppler with image documentation X

Effective: 1/1/2020 Included w/ Category CPT® Code CPT® Code Description Claims Management Ultrasound 76775 Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; limited X Ultrasound 76770 Ultrasound, retroperitoneal (eg, renal, aorta, nodes), real time with image documentation; complete X Ultrasound, abdominal aorta, real time with image documentation, screening study for abdominal aortic aneurysm Ultrasound 76706 X (AAA)

Ultrasound 76705 Ultrasound, abdominal, real time with image documentation; limited (eg, single organ, quadrant, follow-up) X

Ultrasound 76700 Ultrasound, abdominal, real time with image documentation; complete X

Ultrasound 76642 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; limited X

Ultrasound 76641 Ultrasound, breast, unilateral, real time with image documentation, including axilla when performed; complete X

Ultrasound 76604 Ultrasound, chest (includes mediastinum), real time with image documentation X

Ultrasound 76536 Ultrasound, soft tissues of head and neck (eg, thyroid, parathyroid, parotid), real time with image documentation X , real time with image documentation (gray scale) (for determination of ventricular size, Ultrasound 76506 delineation of cerebral contents, and detection of fluid masses or other intracranial abnormalities), including A- X mode encephalography as secondary component where indicated Unlisted 78999 Unlisted miscellaneous procedure, diagnostic nuclear medicine X Unlisted 78799 Unlisted genitourinary procedure, diagnostic nuclear medicine X Unlisted 78699 Unlisted nervous system procedure, diagnostic nuclear medicine X Unlisted 78599 Unlisted respiratory procedure, diagnostic nuclear medicine X Unlisted 78399 Unlisted musculoskeletal procedure, diagnostic nuclear medicine X Unlisted 78299 Unlisted gastrointestinal procedure, diagnostic nuclear medicine X Unlisted 78199 Unlisted hematopoietic, reticuloendothelial and lymphatic procedure, diagnostic nuclear medicine X Unlisted 78099 Unlisted endocrine procedure, diagnostic nuclear medicine X Unlisted 76499 Unlisted diagnostic radiographic procedure X CPT® copyright 2020 American Medical Association. All rights reserved. CPT is a registered trademark of the American Medical Association.

Effective: 1/1/2020